A THIRD of patients still suffer unacceptable pain two years after a rheumatoid arthritis diagnosis, usually with little inflammation to explain it, a 10,000-patient Swedish study finds, pointing to predictors clinicians could spot at diagnosis.

Pain in Early Rheumatoid Arthritis

Pain that lingers despite controlled inflammation remains a major burden in rheumatoid arthritis (RA), causing suffering, daily limitation, and added morbidity. Identifying who is at risk early matters, because it allows multimodal pain treatment to begin sooner. This study set out to find baseline predictors of such pain in early RA.

Study Design and Pain Assessment

The nationwide cohort study drew on several Swedish national registers, covering 10,297 patients newly diagnosed with RA between 2012 and 2020. Pain was measured on a 0 to 100 mm visual analogue scale, with unacceptable pain defined as above 40 mm and low inflammation as C-reactive protein below 10 mg/L. Logistic regression evaluated baseline predictors of unacceptable pain and of unacceptable pain with low inflammation, while linear mixed-effect models examined predictors of pain from baseline to the two-year follow-up.

Predictors of Unacceptable Pain

Among the 3,427 patients with two-year data, 1,143 (33%) had unacceptable pain, and 808 (26%) had unacceptable pain despite low inflammation. Female sex, worse patient-reported outcomes, low inflammatory markers, and having many tender relative to swollen joints predicted unacceptable pain, unacceptable pain with low inflammation at one and two years, and more pain over time. C-reactive protein was negatively associated with pain. Smoking, non-European origin, and psychiatric or pain-related comorbidity were additionally linked to more pain over time, while patients in their late 60s and early 70s reported less pain than those aged 46 or under.

Implications for Patient Monitoring

The authors concluded that factors beyond inflammation drive much of the unacceptable pain seen at follow-up in early rheumatoid arthritis. They advised clinicians to watch for patients with worse patient-reported outcomes and a mismatch between tender and swollen joints, who may need closer, tailored follow-up. Sex and origin-related differences in pain perception, they added, should inform future pain interventions in early rheumatoid arthritis.

Reference

Eberhard A et al. Predictors of unacceptable pain and the impact of sociodemographic factors and comorbidities-results from a large, nationwide cohort of early rheumatoid arthritis. Annals of the Rheumatic Diseases. 2026;DOI:10.1016/j.ard.2026.05.028.

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